Acute Pancreatitis as a Complication of Adult Henoch-Schonlein Purpura

Pancreatitis is a rare manifestation of adult Henoch-Schonlein purpura (HSP). We describe here a 53-year-old man who presented with acute pancreatitis as a complication of adult HSP. Pancreatic involvement in HSP is self-limiting and benign. Prompt resolution can be achieved by treatment with steroids. Elevated serum amylase and lipase concentrations may be early diagnostic indicators of HSP pancreatitis. Patients with HSP who have abdominal pain should be evaluated for pancreatitis by measuring serum amylase and lipase concentrations and by abdominal computed tomography scan, to plan specific treatment and avoid unnecessary surgery.

Microvascular Pulmonary Tumor Embolism Detected by Perfusion Images of Dual-Energy Computed Tomography / 결핵및호흡기질환

Although advances in multi-detector computed tomography (CT) technique make it possible to evaluate peripheral subsegmental pulmonary arteries, several studies have reported that small peripheral embolisms may still be missed. Recently, some reports demonstrated that dual-energy CT improved the capability to detect peripheral pulmonary embolism. We report a case of lymphoma presenting as disseminated microvascular pulmonary tumor embolism, detected by perfusion images using dual energy CT.

A Case of Adult-onset Still's Disease in a Patient with Ankylosing Spondylitis Complicated with Crohn's Disease

Adult-onset Still's disease (AOSD) is an inflammatory disorder of unknown aetiology characterized by a variety of clinical symptoms. AOSD can precede or occur concomitantly with AS and only a few cases of AOSD with AS have been reported. A 21-year-old man presented with spiking fever, sore throat, arthralgia, maculopapular rash, lymphadenopathy, and chronic inflammatory back pain. His laboratory findings showed marked elevations of liver enzyme, C-reactive protein, erythrocyte sedimentatioin rate, ferritin, and sacroiliitis (grade 2), which were the main characteristics of AOSD and AS. Most symptoms except chronic low back pain were improved after treatment with corticosteroid and disease modifying anti-rheumatic drugs. He was then treated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents to control the disease activity of AS and subsequently showed clinical and serological improvement. This is a first case report of AOSD combined with AS in Korea.

A Case of Acute Eosinophilic Pneumonia after Hematopoietic Stem Cell Transplantation / 결핵및호흡기질환

Pulmonary complications occur in 40~60% of patients who receive hematopoietic stem cell transplantation (HSCT) and are a source of substantial morbidity and mortality. Acute eosinophilic pneumonia (AEP) is an uncommon, non-infectious pulmonary complication occurring in HSCT recipients. We now report the case of a 52-year-old man with AEP who was treated with allogenic HSCT due to acute myeloid leukemia. He complained of fever, cough and dyspnea 390 days after allogenic HSCT. He also had skin and hepatic graft versus host disease (GVHD). Hypoxemia, diffuse pulmonary infiltrates on a chest x-ray and eosinophilia in bronchoalveolar lavage fluid were also noted in several tests. His symptoms, pulmonary infiltrates, hepatic dysfunction and skin lesions rapidly improved after treatment with corticosteroid therapy. Our case supports the idea that AEP is a late phase non-infectious pulmonary complication and one of the manifestations of chronic GVHD.

Endoscopic Resection for Rectal Carcinoid Tumor: Efficacy and Clinical Results of Follow-up

BACKGROUND/AIMS: With the growing volume of screening colonoscopies, the incidence of rectal carcinoids and the number of endoscopic resections for rectal carcinoids are also increasing. However, the prognosis including recurrence and metachronous lesions after endoscopic resection is unclear. METHODS: The medical records of 255 patients who had undergone endoscopic resection for rectal carcinoids between October 1999 and April 2010 were retrospectively reviewed. RESULTS: The number of males was 150 (58.8%), and the mean age was 54.1 years (range, 27-85 years). Mean tumor size was 6.9 mm. In total, 162 cases (63.5%) were treated with endoscopic mucosal resection and 93 (36.5%) were treated with endoscopic submucosal dissection. Although endoscopic complete resections were achieved in all cases, the histological examination showed 47 cases with a positive resection margin (18.4%) and three with lymphovascular invasion (1.2%). In the 54 patients with a free resection margin, who were followed for more than 12 months, abdominopelvic computed tomography and endoscopy did not show recurrence after a median of 30.5 and 36 months, respectively. Three patients with lymphovascular invasion did not show recurrence during follow-up period of 13, 30, and 37 months, respectively. Metachronous rectal carcinoids were detected in four patients at 23, 58, 61, and 89 months, respectively, after initial endoscopic resection, leading to a second endoscopic treatment. CONCLUSIONS: Small rectal carcinoids completely resected grossly and pathologically without lymphovascular invasion appear to have low probability of short-term recurrence. However, considering the slow growth rate of carcinoids, long-term follow-up for recurrence and metachronous carcinoids is required.